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Behind the Cover Story: Suzy Hansen on Improving Health in Mississippi, the Iran Way

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Behind the Cover Story: Suzy Hansen on Improving Health in Mississippi, the Iran Way

By Rachel Nolan July 30, 2012 1:50 pmJuly 30, 2012 1:50 pm

Pankaj Mishra

Suzy Hansen, a journalist based in Turkey, wrote this week’s cover story about trying to import a health care approach from Iran — local health houses staffed by community health workers who check in on patients at their homes — to rural Mississippi. Hansen’s last article for the magazine was on Istanbul’s art scene.

How did you first hear about this program in Mississippi?

A year ago, a friend sent me a link to a short story about it in AARP magazine. I thought that it could be a deeper story — about why this doctor, Aaron Shirley, after decades of working on health care for the poor, would turn to a health care model from a country less developed and with fewer resources than the United States. And what does the idea itself — especially the fact that it’s so basic — tell us about the state of American health care?

You write that this part of the U.S., the Mississippi Delta, doesn’t look terribly poor on first glance. What else surprised you when you got there?

I think Claudia Cox, a nurse I wrote about in the article, said it the best: poverty “used to be bare feet, now it’s Nikes.” When you hear how poor people are in Mississippi, there’s a part of you that expects to see incredibly dramatic scenes. And they certainly exist. But there was another layer of poverty in Mississippi that was more surprising to me. I live in Turkey, and there the poor don’t have possessions. You walk into an apartment or a house and sense the deprivation immediately. Poor Americans, on the other hand, often have stuff. But that doesn’t mean they aren’t terribly poor. That doesn’t mean they aren’t hanging on by a thread, drowning in debt, or unable to get adequate health care.

Because places with widespread health problems can correlate with high unemployment, how easy is it to staff the health services you write about once they are financed?

There aren’t enough trained people for these jobs in poor states like Mississippi. Dr. Shirley said there are lots of nursing positions that need to be filled in the state. It’s hard to keep doctors and nurses and well-trained people there. But I think it also raises the questions of why all these unemployed people aren’t getting the education, seeking the education, staying in school, finding these opportunities or getting help to find them.

Did the people you spoke with in Mississippi talk about the Affordable Care Act at all?

Not very much. Doctors and political types were talking about it, and many are outraged about opposition to the Affordable Care Act in the state. But the sick people I interviewed didn’t bring it up. They’re mostly just trying to get through today and tomorrow and deal with the circumstances they have. They did express a sense of being left behind, though they never blamed anyone for that.

Are the sick people you interviewed aware that the idea for the program originated in Iran?

No, I don’t think they know, and I doubt they’d care. Obviously some politicians would find the Iran connection more distasteful than others. At one point during the process of setting it up, Mississippi’s former governor Haley Barbour declared Iran the world’s No. 1 threat. That’s the climate.

And yet Iranians who came to Mississippi were shocked at the deficiencies of the U.S. health care system?

I think they were surprised by the level of poverty, just as I was, and as many people probably would be. But American poverty can come as more of a surprise to foreigners who think of America as the land of opportunity and prosperity.

Are there any plans to scale up and take the program to other places?

It may be possible to replicate aspects of the Iranian model in Mississippi, but if they can’t integrate health houses with hospitals, then their version will always lack a kind of efficiency and continuity of care.

You write that a lot of money pours into the Mississippi, and the delta is studied and studied, but nothing changes. Where does all that money go?

That’s somewhat of a mystery. One of the problems with research is that eventually the researchers pack up and leave. It’s the problem of sustainability. Another person expressed it to me as a problem of disconnectedness. There are so many competing groups who want money for different programs and initiatives, but are they working together to get at the heart of the problems? You might improve teen pregnancy rates in one town, but then what about diabetes? And even if you “fix” health care, how great can anyone’s life be without good jobs? The problems are endless. There are also so many wonderful, devoted people working to change things in Mississippi. But you leave there feeling like the larger system just doesn’t work.

What have reactions to your article been like?

People just keep writing about how sad they are about the situation in Mississippi. I also saw that one of the commenters remarked that he rarely reads positive articles about Muslim countries in the American press.

Bruce Grierson wrote this week’s cover story about Ellen Langer, a Harvard psychologist who has conducted experiments that involve manipulating environments to turn back subjects’ perceptions of their own age.Read more…